Device for the osteosynthesis of a spinal segment

ABSTRACT

Device for the osteosynthesis of a spinal segment by the anterior route, which comprises at least two bone anchorage elements for anchorage in the vertebral bodies by the anterior route, a frame comprising a rod adapted to be received in the bone anchorage elements, a plate disposed roughly parallel to the rod and rigidly connected to the latter to form a closed frame. Means are provided for clamping the rod in the anchorage elements so as to fix the latter at a predetermined distance apart, and screws extend through openings in the plate which are so profiled that the screwing of the screws in the vertebrae automatically brings the two adjacent vertebrae closer together and thus achieves a compression of an intervertebral filler replacing a vertebral disk. The association of a plate and a rod in the form of a frame affords the advantage of providing four vertebral anchorage points instead of only two in devices of the prior art, which prevents any offsetting of one vertebra relative to the other.

BACKGROUND OF THE INVENTION

The present invention relates to a device for the osteosynthesis of aspinal segment and more particularly, but not exclusively, a device forosteosynthesis of the spine by the anterior route for the correction ofvertebral deformations and degenerations. Among portions of the spine towhich these devices may be particularly adapted include the thoracic,thoraco-lumbar, and lumbar spinal segments.

Systems are known in the art which employ rods alone, plates alone, androd-plates interconnected in such a manner that the plate extends therod substantially on the longitudinal axis of the latter. Thus the U.S.Pat. No. 5,507,745 describes a rod-plate adapted for anoccipito-cervical assembly. The document EP 0,553,042 also teaches theuse of a device of the rod-plate type, the plate being in the extensionof the longitudinal axis of the rod, this system being particularlyadapted for the lumbar-sacral articulation. Once drawback of suchrod-plate systems resides in the fact that one of the vertebrae maybecome undesirably offset relative to the other.

In conventional open surgical interventions involving the removal of adisc, a fusion cage or a graft is placed in position to restore thediscal height, and then the two adjacent vertebrae are compressedmanually for maintaining in place the bone graft or the cage. Within theframework of the development of surgical interventions by endoscopy andby the anterior route (i.e. with a small-section abdominal openingthrough which trocars and a closed-circuit micro-television camera areinserted), the compression of the two vertebrae presents a particulardifficulty. Heretofore, the surgeons did not add a material or contentthemselves to stabilize the instrumentation. Thus, there is a need fordevices and methods to address these shortcomings.

SUMMARY OF THE INVENTION

One form of the present invention is a unique medical treatment device.Other forms include unique osteosynthesis devices and methods.

In another form of the present invention, an osteosynthesis devicecomprises a rod and a plate disposed substantially parallel to the rodand rigidly connected to the same, and bone anchoring means for engagingthe rod and the plate to a spinal segment. Such a system can be equippedwith four anchoring elements to address problems regarding relativedisplacement between vertebrae.

In a further form, a device according to the invention extends over aspinal segment of at least two vertebrae. A surgeon extracts thedefective intervertebral disk and then inserts, instead of the disk, afiller, which can be, for example, a bone graft or one or moreintersomatic cages. A compression of the graft or the cages is performedto thereby bring the two vertebrae closer together, which vertebrae arethereafter fixed in position.

According to another form, the device comprises means cooperative withthe plate for bringing closer together two adjacent vertebrae into eachof which an anchorage element is placed; whereby to effect a compressionof a filler between the two vertebrae which replaces a removed vertebraldisk.

A further form of the invention includes a plate and a rodinterconnected at their facing ends by lugs forming with the rod and theplate a substantially rectangular frame, and means for bringing twoadjacent vertebrae closer together. Such means may comprise a pair ofoblong openings formed in the plate that extend in a direction parallelto the rod in facing relation to each vertebra, and screws adapted to beanchored in the corresponding vertebral body through said openings, thelatter and the screws being so arranged that the progressive screwing ofthe screws brings the two vertebrae closer together. The openings eachhave a wall defining at its base a ramp which slopes toward the centralpart of the plate and in the direction toward the surface of the platebearing against the vertebrae. For this form, the wall/ramp arrangementis formed of a succession of spherical segments and is connected by acylindrical portion to the bearing surface, and the screws associatedwith these openings have heads arranged to engage the walls.

Accordingly, one object of the Invention is to provide devices andmethod for medical treatment procedures.

Another object is to provide a device for osteosynthesis arranged insuch a manner as to facilitate compression of adjacent vertebrae.

Further objects, forms, embodiments, aspects, benefits, features, andadvantages of the invention will be clear from the following descriptionwith reference to the accompanying drawings which illustrate severalembodiments of the invention by way of non-limiting examples.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a view of a vertebra substantially to scale in a horizontalplane and a top end elevational view of an embodiment of the spinalosteosynthesis assembly according to the invention in position in thisvertebra.

FIG. 2 is a longitudinal elevational view to a larger scale of therod-plate frame forming part of the osteosynthesis assembly of FIG. 1.

FIG. 3 is a perspective view of the rod-plate frame of FIG. 2.

FIG. 4 is a perspective view in another direction of the rod-plate frameof FIG. 3, showing more particularly the oblong openings in the plate.

FIG. 5 is a perspective view to a larger scale of the assembly forosteosynthesis by the anterior route of FIGS. 1 to 4 anchored on aspinal segment of two vertebrae.

FIG. 6 is a partial sectional view taken along section line 6—6 of FIG.2.

FIG. 7 is a longitudinal elevational view in a sagittal plane of theosteosynthesis assembly of FIGS. 1 to 6 placed in position on twovertebrae spread apart after extraction of the intervertebral disk.

FIG. 8 is a view similar to FIG. 7 showing the two vertebrae broughtcloser together and the compression of the bone graft and/orintersomatic cage after the screwing of the screws of the plate into thetwo vertebrae.

FIGS. 9 and 10 are perspective views illustrating two other embodimentsof the rod-plate system according to the invention.

FIG. 11 is a perspective view of yet another embodiment of the presentinvention.

DESCRIPTION OF SELECTED EMBODIMENTS

For the purposes of promoting an understanding of the principles of theinvention, reference will now be made to the embodiments illustrated inthe drawings and specific language will be used to describe the same. Itwill nevertheless be understood that no limitation of the scope of theinvention is thereby intended, such alterations and furthermodifications in the illustrated device, and such further applicationsof the principles of the invention as illustrated therein beingcontemplated as would normally occur to one skilled in the art to whichthe invention relates.

FIG. 5 illustrates device 110 of one embodiment of the presentinvention. Device 110 may be for the osteosynthesis of a spinal segmentformed, for example, by two lumbar or thoracic vertebrae L3, L2 placedin position by the anterior route. Device 110 includes a number of boneanchorage elements 101, four of which are illustrated in FIG. 5 as apair of screws 1 and a pair of screws 16. At least two bone anchorageelements, such as two screws 1, are for anchoring in the correspondingvertebral bodies; these screws 1 may be for example, of the type havinga U-shaped head 2 the inner faces of which are threaded or tapped forreceiving a clamping element in the form of threaded plug 3 providedwith a terminal portion 4 which may be broken off at fracture line 20 byexerting a predetermined fracture torque. Such a clamping element isdescribed in French patent No. 2,723,837 (94,10,377), the disclosure ofwhich is incorporated in the present specification by reference.Nonetheless, in other embodiments,, terminal portion 4 may not befrangible.

Device 110 also includes an implant structure 105 provided in the formof frame 5. Frame 5 is comprised of rod 6 interconnected to plate 7 byconnection members 8 a. Rod 6 is preferably cylindrical and adapted tobe received in the U-shaped heads 2 of the anchorage screws 1, bybearing against the bottom of the U-shaped passage, and clamped inposition by the threaded plugs 3. Accordingly, rod 6 may be fastened toscrew 1 between U-shaped head 2 and plug 3. Plate 7 is disposedapproximately parallel to rod 6 and extends therealong. Plate 7 issubstantially of the same length as rod 6, and rigidly connected to thelatter in a side by side relationship to form frame 5 in a closedconfiguration.

Referring additionally to FIGS. 2-4, plate 7 and the rod 6 areinterconnected at their opposite end portions 7 b, 7 c and 6 b, 6 c,respectively; by a number of connection members 8 a in the form of lugs8 constituting with the rod 6 and the plate 7 a substantiallyrectangular shape or profile of frame 5. Preferably, lugs 8 each have alongitudinal axis that is inclined at a given angle A relative to theplane P along which plate 7 lies, for example at between about 30 andabout 45° (FIGS. 3 and 5), so that the rod 6 is offset relative to theplane P of the plate 7. Plane P is generally parallel to a longitudinalaxis of plate 7. Lugs 8 may be either in one piece with the rod 6 and/orplate 7 or detachably fixed to rod 6 and/or plate 7 by any suitablemeans. For example, the ends of one or more of the lugs 8 remote fromthe plate 7 may be arranged in the shape of a cup for fitting onto theends of rod 6 to which they are fixed by any suitable means, whichpermit, if required, removing lugs 8 from rod 6. In other embodiments,one or more of lugs 8 may be releasably fastened at plate 7. In stillother embodiments, a fixed spatial relationship between rod 6 and plate7 may be maintained by members 8 a; however, rod 6 may be allowed torotate between lugs 8.

Arranged in plate 7 is at least a pair of oblong openings 9 which extendin a direction parallel to rod 6 in facing relation to the intendedposition of each vertebra, such as L2, L3. Each opening 9 has a wall 12defining at its base adjacent to the corresponding vertebra L2 or L3, atleast one ramp 11, preferably two ramps 11 as in the illustratedembodiment (a ramp 11 for each wall 12), which slopes toward the centralpart 7 a of the plate 7 and in the direction toward the surface 13 ofthe plate 7 bearing against the vertebrae L2, L3. Referring morespecifically to FIGS. 4, 7, and 8, the two pairs of ramps 11 of the twoopenings 9 thus have respective slopes at a relatively small angle, forexample 8° to 10°, which converge toward axis M as shown in FIG. 7.

Referring next to FIGS. 5-8, in the direction away from the bearingsurface 13, each ramp 11 adjoins a surface constituting the wall 12which is formed, when viewed in cross section (FIG. 6), of a successionof spherical segments. At the lower ends of the latter, the ramps 11form edges from which a short cylindrical portion 14 extends to thebearing surface 13. This profile corresponds to and is adapted to matewith that of a head 17 of a screw 16 having a spherical portion 17 a.Head 17 is connected to an unthreaded intermediate portion 16 a of screw16. Portion 16 a is connected to threaded shank 15 of screw 16. Head 17of screw 16 also is extended by a terminal polygonal profile 17 b, forexample a hexagonal profile, opposite threaded shank 15.

The profile of openings 9 may be provided by machining with acorrespondingly shaped rotating member (not shown) which travels fromone end to the other of each opening 9 as it machines the sphericalwalls 12 and the ramps 11 at the required slope. Associated with theseprofiled openings 9 are respective screws 16 each having a sphericalhead 17 with spherical portion 17 a. Spherical portion 17 a has a radiusof curvature which is substantially equal to that of spherical segmentsof wall 12, so that the heads 17 of the screws 16 (FIGS. 7 and 8) canslide from one end to the other of the ramps 11 as the screws 16 areprogressively screwed into the respective vertebrae L2, L3.

The spinal osteosynthesis device just described is preferably mounted inthe following manner:

(a) The surgeon places the two screws 1 in position by anchoring them bythe anterior route into the selected vertebrae, for example L2 and L3.

(b) He disposes the cylindrical rod 6 in the heads 2 of the screws 1 andplaces the plugs 3 in position in the heads 2, respectively;

(c) The surgeon then places the plate 7 of the frame 5 against thevertebral bodies and inserts the screws 16 in the outer ends of theopening 9 where the heads 17 bear against the uppermost ends of theramps 11 (FIG. 7), and screws 16 are turned until they bear against theends of the spherical walls 12 and of the ramps 11, taking care toapproximately direct the threaded shanks 15 toward the center of gravityor centroid of the vertebrae, which facilitates the subsequentcompression; and

(d) The surgeon completes the screwing of plugs 3 until theself-breaking terminal portions 4 break off along their fracture line 20(FIG. 5) when the predetermined fracture torque is reached. The placingin position of the system for the spinal osteosynthesis by the anteriorroute for this embodiment has now finished. It should be understood thatwhile placement by an anterior route is preferred for this embodiment,in other embodiments a different placement route may be utilized.Likewise, the devices of the present invention may be used withendoscopic and/or non-endoscopic procedures.

It is envisioned that screws 16 may be self-cutting or not self-cutting.In the case where the screws 16 are self-cutting, the surgeon screwsthem directly into the vertebral bodies without raising the plate 7. Asthe screws 16 are progressively screwed, the heads 17 contact and slidealong the spherical walls 12 and the ramps 11 in the direction towardthe center part of plate 7, which causes the vertebrae L2, L3, drivenalong by the screws 16, to move toward each other. This movement towardeach other and the corresponding compression of a filler G (see FIGS. 5and 8); such as an osteogenic material, an intervertebral graft, orintersomatic cage(s) disposed in the intervertebral space; stops whenthe surgeon thinks filler G is sufficiently compressed. In the casewhere the screws 16 are not self-cutting, the surgeon first raises theplate 7, drills and taps the openings for the screws (after optionallyhaving center-punched the exact position of the latter). He then placesthe plate 7 back against the vertebrae and screws the screws 16, with acorresponding movement of the vertebrae closer together and compressionof filler G.

The arrangement of the oblong openings 9 with their spherical walls 12and their ramps 11 so inclined as to converge toward the center part 7 aof plate 7, permits bringing the vertebral bodies closer together andconsequently automatically compressing filler G as the screws 16 areprogressively screwed into position. This is but one advantage withinthe framework of a surgical intervention by endoscopy. Anotherappreciable advantage of device 110 according to the invention resultsfrom the association of the rod 6 and plate 7 in parallel to form frame5. Indeed, the latter provides four vertebral anchorage points (the fourscrews 1 and 16) which reduce displacement or offsetting of one vertebrarelative to the other. Still, in other embodiments, a different numberof screws and corresponding openings may be utilized.

In the alternative embodiment of FIG. 9, rod 6 is rigidly connected toplate 21 in their respective central parts by another type of connectionmember 8 a, strut 22, so that the assembly generally defines a rigidH-shaped structure 106.

FIG. 10 illustrates implant structure 116 of a further embodiment of thepresent invention. For structure 116, rod 6′ and the plate 7′ areinterconnected to extend upon a length corresponding to a spine segmentof three vertebrae. For this embodiment, three bone anchorage screws 1are shown in phantom, one for each of the three vertebrae. The plate 7′is provided in its central part with a bone anchoring element hole 20aligned with the central vertebra. On each side of the central part, theplate is pierced with oblong openings 9′ accommodating screws 16. Thecentral screw is used for fixing the frame 6′/plate 7′ on the centralvertebra. The screwing of screws 16 into openings 9′ bringsprogressively both end vertebrae closer to the central vertebra untilthe surgeon thinks that the graft is sufficiently compressed. In analternative embodiment, this arrangement can be designed on theembodiment of FIG. 9, in order that the assembly rod-plate extends alsoupon three vertebrae.

In yet another embodiment of the invention shown in FIG. 11, plate 25 isinclined at an angle (θ) in regard to the longitudinal axis (XX) of rod6 to provide implant structure 126. Accordingly, for structure 126,while rod 6 and plate 25 are still in a side by side orientation, thelongitudinal axis XX of rod 6 is oblique with respect to a longitudinalaxis of plate 25. The oblong openings 9 extend, within plate 25, alongto axis (YY) which is generally parallel to the longitudinal axis XX ofrod 6.

It must be understood that the scope of the invention is not intended tobe limited to the described elements and may include various variants.Thus the rod 6, 6′ could be non-cylindrical, the inclination A of thelugs 8 to the plane of the plane of the plate 7, 7′ may vary widely, inthe same way as the geometry of the walls of the openings 9, 9′ and ofthe screws 16, any profile allowing the sliding of the screws to achievean automatic compression of a filler, e.g., an osteogenic material, agraft or the intersomatic cage being suitable. Also, in otherembodiments, openings 9, 9′ can be arranged without the inclined ramps11, where compression of the graft/filler is not desired, or achieved ina different way.

In still other alternatives, the bone anchoring means of rod 16 can bedifferent from U-shaped screws 1; for example they can be of the kinddisclosed in European patent 0,612,507 or in French patent 2,692,471(92,07,504). The intervertebral filler can be an allograft, anautograft, a xenograft, an intervertebral device or cage; anotherosteogenic substance to promote fusion of the adjacent vertebrae, or acombination of these just to name a few.

Many other embodiments are envisioned. For example, in yet anotherembodiment, a device for osteosynthesis of a spinal segment of two ormore vertebrae by an anterior route comprises a rod, plate, and aconnection member interconnecting the plate to the rod. The plate isdisposed substantially parallel to the rod in a spaced apartrelationship by the first connection member. Further, the deviceincludes bone anchoring means for engaging the rod and the plate to thevertebrae.

In still a further form, a device for osteosynthesis of a spinal segmentincludes a rigid implant structure having a rod interconnected to aplate by a connection member. The plate includes a surface arranged toengage the spinal segment and the rod extends along the plate in aspaced apart relationship. The rod is further away from the spinalsegment than the plate when the plate surface engages the spinalsegment. A first bone anchorage element selectively contacts the rod tofasten the rod to the spinal segment. The first bone anchorage elementincludes a portion positioned between the plate and the rod whenfastened to the rod. A second bone anchorage element selectivelycontacts the plate to fasten it to the spinal segment.

In yet a further embodiment, a device for osteosynthesis of a spinalsegment comprises a rod, a plate, and a connection memberinterconnecting the rod and plate such that the plate is positioned bythe connection member to extend along the rod with a surface arranged tocontact the spinal segment. The connection member is inclined relativeto a plane of the plate to offset the rod from the plate in a side byside, spaced apart relationship, and position the rod superjacent to thespinal segment when the plate surface contacts the spinal segment.

According to another embodiment of the present invention, a methodcomprises: (a) removing at least a portion of a disc between twoadjacent vertebrae; (b) placing a filler between the two adjacentvertebrae; (c) providing a device comprised of a plate interconnectedwith a rod in a spaced apart relationship and a number of bone anchorageelements; and (d) compressing the two adjacent vertebrae with the deviceafter placement of the filler.

According to yet another embodiment, a method comprises: (a) placing afirst bone anchorage element in a first vertebra and a second boneanchorage element in a second vertebra adjacent the first vertebra; (b)providing a rod interconnected to a plate that extends along the rod andincludes a first opening and a second opening; (c) engaging the rod tothe first and second bone anchorage elements; (d) inserting a first bonescrew through the first opening and a second bone screw through thesecond opening; and (e) turning the first bone screw and the second bonescrew to move the first vertebra and the second vertebra closertogether.

The screws, plates, and rods of the present invention are preferablymade from a biocompatible material of suitable strength such astitanium, stainless steel, or such other composition as would occur tothose skilled in the art.

All publications, patent, and patent applications cited in thisspecification are herein incorporated by reference as if each individualpublication, patent, or patent application were specifically andindividually indicated to be incorporated by reference and set forth inits entirety herein. Any theory of operation or finding described hereinis merely intended to enhance understanding of the present invention andshould not be construed to limit the scope of the present invention asdefined by the claims that follow to any stated theory or finding. Whilethe invention has been illustrated and described in detail in thedrawings and foregoing description, the same is to be considered asillustrative and not restrictive in character, it being understood thatonly the preferred embodiment has been shown and described and that allchanges, modifications, and equivalents that come within the spirit ofthe invention as defined by the following claims are desired to beprotected.

What is claimed is:
 1. Device for the osteosynthesis of a spinal segmentof two or more vertebrae by the anterior route, comprising: a rod; aplate; a connection member interconnecting said plate to said rod, saidplate being disposed substantially parallel to said rod in a spacedapart relationship by said connection member; said plate including asurface arranged to contact the vertebrae; and bone anchoring means forengaging said rod and said plate to the vertebrae, said means comprisingat least a pair of oblong openings formed in said plate and each of saidopenings has a wall including a ramp adapted to slope toward a centralpart of said plate.
 2. Device according to claim 1, wherein saidconnection member is a strut generally centrally located relative tosaid rod and said plate.
 3. Device according to claim 1, wherein saidplate and said rod have substantially the same length and saidconnection member is one of a pair of lugs interconnecting said plateand said rod to form a substantially rectangular frame.
 4. Deviceaccording to claim 3, wherein said plate extends in a plane and saidlugs are inclined relative to said plane to offset said rod relative tosaid plate.
 5. Device according to claim 3, wherein said lugs areintegrally formed in a single piece with said rod and said plate. 6.Device according to claim 3, wherein said rod has a first end portionand an opposite second end portion and a first one of said lugs isdetachably connected to said first end portion and a second one of saidlugs is detachably connected to said second end portion.
 7. Deviceaccording to claim 1, further comprising means cooperative with saidplate for bringing closer together adjacent ones of the vertebrae tocompress a filler between the adjacent vertebrae.
 8. Device according toclaim 1, wherein said bone anchoring means comprises a plurality of boneanchorage elements, a first one of said elements having a U-shaped headto engage said rod and a second one of said elements having a threadedshank portion arranged to pass through an opening in said plate and ahead portion arranged to engage a wall adjacent said opening, said headportion being shaped to compliment a profile of said wall.
 9. Acombination, comprising: a device for osteosynthesis of a spinalsegment, said device including: a rigid implant structure including arod interconnected to a plate by a connection member, said plateincluding a surface arranged to engage the spinal segment and a pair ofopenings formed in said plate and each of said openings has a wallincluding a ramp adapted to slope toward a central part of said plate,said rod being positioned to extend along said plate in a spaced apartrelationship, and said rod being further away from the spinal segmentthan said plate when said surface engages the spinal segment; a firstbone anchorage element operable to selectively contact said rod tofasten said rod to the spinal segment; and a second bone anchorageelement operable to selectively contact said plate to fasten said plateto the spinal segment.
 10. The combination of claim 9, wherein saidconnection member is a strut generally centrally located relative tosaid rod and said plate.
 11. The combination of claim 9, wherein saidconnection member is one of a pair of opposed lugs interconnectingopposite end portions of said plate and said rod to form a substantiallyrectangular frame.
 12. The combination of claim 9, wherein said rod isoffset relative to said plate by said connection member.
 13. Thecombination of claim 9, wherein said second bone anchorage element is inthe form of a screw including a threaded shank portion and a headportion arranged to contact said wall and travel along said ramp whensaid threaded shank portion is screwed into a vertebra of the spinalsegment through one of said openings.
 14. The combination of claim 9,wherein said first bone anchorage element includes a U-shaped head toengage said rod.
 15. The combination of claim 14, wherein said U-shapedhead is threaded and further comprising a threaded plug arranged toengage said head and contact said rod.
 16. The combination of claim 15,wherein said plug includes a terminal portion arranged to break-off whena predetermined amount of torque is applied to said plug.
 17. Thecombination of claim 9, wherein said second bone anchorage element beingarranged to pass through a first one of said pair of openings to engagea first vertebra of the spinal segment and further comprising a thirdbone anchorage element to pass through a second one of said pair ofopenings to engage a second vertebra of the spinal segment.
 18. Thecombination of claim 17, wherein said first bone anchorage elementengages the first vertebra of the spinal segment and further comprisinga fourth bone anchorage element to engage the second vertebra of thespinal segment, said first bone anchorage element and said second boneanchorage element each including a U-shaped head to receive said rod.19. The combination of claim 17, wherein said second bone anchorageelement and said third bone anchorage element each being in the form ofa screw with a head portion arranged to engage and travel along saidramp when driven through said openings.
 20. The combination according toclaim 17, further comprising a filler configured for placement betweenthe first vertebra and the second vertebra.
 21. The combination of claim9, wherein said rod defines a longitudinal axis, and said plate isinclined in regard to said longitudinal axis of said rod wherein saidpair of openings are oblong and extend through said plate substantiallyparallel to said longitudinal axis.
 22. The combination of claim 9,wherein said rod and said plate extend to a length substantiallycorresponding to at least three vertebrae and, said plate includes athird opening wherein the three openings correspond with the at leastthree vertebrae, a first one of the openings being arranged forengagement by said second bone anchorage element and further comprisinga third bone anchorage element arranged to engage a second one of theopenings and a fourth bone anchorage element arranged to engage a thirdone of said openings.
 23. A device for osteosynthesis of a spinalsegment; comprising a rod, a plate, and a first connection memberinterconnecting said plate to said rod, said plate being disposed toextend along said rod by said first connection member, said plateincluding a surface arranged to contact the spinal segment, said firstconnection member being inclined relative to a plane of said plate suchthat said rod is offset above and lateral to said plate and positionedsuperjacent to said spinal segment when said surface contacts saidspinal segment.
 24. The device of claim 23, further comprising a secondconnection member interconnecting said rod and said plate, said secondconnection member being positioned opposite said first connection memberto provide a generally rectangular frame.
 25. The device of claim 23,wherein said first connection member is in the form of a strut generallycentrally located relative to said rod and said plate.
 26. The device ofclaim 23 further comprising a plurality of bone anchorage elements, afirst one of said bone anchorage elements being arranged to connect tosaid rod and a second one of said bone anchorage elements being arrangedto extend through an opening in said plate.
 27. A method, comprising:removing at least a portion of a disk from between two adjacentvertebrae; placing a filler between the two adjacent vertebrae;providing a device comprising: a rod; a plate; a connection memberinterconnecting said plate to said rod, said plate being disposedsubstantially parallel to said rod in a spaced apart relationship bysaid first connection member; said plate including a surface arranged tocontact the vertebrae; and a bone anchoring means for engaging said rodand said plate to the vertebrae; and compressing the two adjacentvertebrae with the device after placement of the filler therebetween.28. A method, comprising: placing a first bone anchorage element in afirst vertebra and a second bone anchorage element in a second vertebraadjacent the first vertebra; providing a rod interconnected to a plate,the plate extending along the rod and including a first opening and asecond opening; engaging the rod to the first and second bone anchorageelements; inserting a first bone screw through the first opening and asecond bone screw through the second opening; and turning the first bonescrew and the second bone screw to move the first vertebra and thesecond vertebra closer together.
 29. The method of claim 28, furthercomprising approaching the first and second vertebrae by an anteriorroute.
 30. The method of claim 28, further comprising: removing at leasta portion of a disk from between the first and second vertebrae; andimplanting a filler between the first and second vertebrae.